Freefall into Madness: The Fresno County Jail’s Barbaric Treatment of the Mentally Ill

For the past six years, in an effort to cut costs, the Fresno County Jail has repeatedly denied mentally ill defendants the anti-psychotic medications prescribed to them by their outside doctors—medications needed to keep them sane.

As a result, according to Fresno County judges, former nurses, correctional officers, doctors, lawyers and the families of the defendants, the jail medical staff is triggering psychotic breakdowns in people suffering from bipolar disorder and schizophrenia.

The Fresno County Jail

The prolonged mental breakdowns are causing some defendants to languish in isolated confinement for years at a time, they say, creating a system of mental torture at the county jail. Denied their usual medications, defendants suffer paranoid delusions and mania so debilitating that some have tried to commit suicide multiple times in jail, slashing their throats or wrists with county-issued razors.

Because they are not mentally competent to stand trial, they bounce back and forth in a perverse revolving door between the county jail and state mental hospitals, costing taxpayers even more money.

“It is just unconscionable to have some of these people who are severely mentally ill be denied medication and then suffer the kinds of symptoms they are suffering in jail,” Fresno County Superior Court Judge Jonathan Skiles said. “I’ve seen it happen a number of times, and I just don’t understand it. Any of those terms—‘barbaric, medieval’—could apply.

“As for saving money, it might save our jail a little in prescription drug costs, but it’s costing the overall system a lot more.”

In numerous instances, the county’s treatment of defendants with long-term mental disease reveals the same troubling pattern:

A person suffering from bipolar disorder or schizophrenia is charged with a crime and sent to the Fresno County Jail. The jail doctor decides to deny him the anti-psychotic medication he has taken for years; the defendant then deteriorates to the point that he is mentally unfit to face trial. A frustrated judge signs an order transferring the defendant to a state facility. The defendant receives anti-psychotic medication at the state hospital and regains his mental competency, only to be returned to the Fresno County Jail where the withholding of medication occurs again.

In this way, interviews and documents show, justice is denied and mental torment is inflicted—in some cases, year after year and with tragic consequences.

Dr. Howard Terrell, a board-certified psychiatrist who is often asked by Fresno County judges to serve as a court expert, said he has witnessed dozens of cases where mentally ill defendants—denied their medications by the county jail—become too psychotic to stand trial.

“I’ve seen defendants for the court who were so severely psychotic that they had to be sent off to Atascadero State Hospital or Metro State Hospital, where they were put on the proper anti-psychotic medications and came back fine. But the jail would discontinue their meds by issuing a new diagnosis or just taking them off for no good reason, and they rapidly deteriorated from being quite competent to being psychotic again.

“This happened again and again through the same revolving door. Just tragic. Over and over. Just horrible. It’s immoral.”

Judge Skiles recounted a recent case where the defendant ping-ponged between Fresno County Jail and Atascadero State Hospital three times as the jail withheld his anti-psychotic medication. This not only caused unnecessary mental torment to the defendant and anguish to his family but added to the costs of prosecutors, public defenders, the court and local and state lockups.

Skiles said he became so frustrated by the case that he ordered the jail psychiatrist to give the defendant “any and all medications” prescribed by the state hospital. Skiles said he even threatened to hold the jail psychiatrist in contempt of court if he refused. Skiles then learned from his superiors that he didn’t have the authority to issue such an order.

“I found out that I couldn’t supersede the relationship between the jail doctor and the defendant. And I had no authority to hold him in contempt,” he said. “I really wish I had a tool at my disposal to address this issue, but unfortunately I don’t or at least I haven’t discovered it yet.”

The few county officials willing to talk on-the-record about the jail’s treatment of the mentally ill say the portrait of an institution practicing “cruel and unusual punishment” is overblown, lacking the proper context and outdated. What problems existed in the past, they say, mostly have been ironed out.

“Certainly, there are areas we need to improve on, but I don’t think it is as bad as people make it sound,” said Lt. David Kurtze, head of the jail’s custody staff.

“We have a medical staff that goes around distributing meds. [The inmates] may choose to not take them. We cannot force them to take the meds. We give them the choice.”

But critics who have studied the jail system and watched it evolve over the past decade say every level of the county’s bureaucracy—the Board of Supervisors, the county administrative officer, the sheriff, the jail medical staff, the county public health officer—has helped institutionalize a methodology of mental torture, turning it into an apparatus of the bureaucracy. Then each level turns blind and silent to its consequences.

“This county doesn’t care about its treatment of mentally ill behind bars or otherwise.” —Susan Anderson, retired member of the Board of Supervisors

“This county doesn’t care about its treatment of mentally ill behind bars or otherwise,” said Susan Anderson, the recently retired supervisor who watched her colleagues on the board implement cut after cut to the county’s mental health budget until, she said, there was nothing left but skin and bones.

“If the Board of Supervisors wanted mentally ill defendants to get their anti-psychotic medications in jail, all they would need to do is direct the sheriff, the health officer and the jail doctor to do it,” Anderson said. “But the thinking of the board, the sheriff’s [office] and the rest of the criminal justice system here is not about prevention or humanity. It’s all about punishment.”

Over the past four months, Fresno State journalists working with their professor, Mark Arax, have documented a half dozen cases where jail medical staff withheld anti-psychotic or mood stabilizing drugs to defendants with longstanding diagnoses of schizophrenia or bipolar disorder. In each case, medical documents and interviews show, the defendant’s mental state quickly deteriorated, a freefall into madness.

Wesley Alexander, a bipolar man in his 40s, was denied his anti-psychotic medications in 2012 and lost nearly 80 pounds as he sat in an isolated cell in Fresno County Jail for five months, interviews show. At one point, he turned his sock into a sponge so he could drink water from a hole in the floor where he went to the bathroom. In a recent interview from Atascadero State Hospital, Alexander said he went insane at the jail while awaiting trial and tried to kill himself, slitting his wrist with a jail-issued razor.

“It was terrifying. I didn’t know what to do. I was in turmoil. I was frightened. I was scared,” Alexander said. “I’ve never been in a situation like that in my life.”

Travis Fendley, a 23-year-old schizophrenic with a history of violence, was well known inside the Fresno County Jail. Since 2010, he was incarcerated there four times. His family said they pleaded on several occasions with county nurses and jailers that he needed the same anti-psychotic medication prescribed by outside doctors or he was going to hurt himself or someone else. Denied those medications each time behind bars, his family says, he twice tried to kill himself, once by attempting to drown himself with cups of water and then by slitting his throat.

As Fendley cycled in and out of the jail over a two-year period on charges that ranged from stealing his grandmother’s car to attempting to suffocate his infant daughter, he continued to deteriorate mentally. Then last December, he was brought back into the jail for hitting his grandmother on the head. His mother and aunt said they personally went down to the jail and warned staff that he was “going to kill someone.” Hours later, gripped by psychosis, Fendley was released from jail. He walked for miles in the dark of early morning to his grandmother’s home, where he then suffocated her to death.

“We called [the jail] five or six times begging them to give Travis his medications,” said Becky Alford, Fendley’s aunt. “[Travis] told us he didn’t know how much longer he could fight the demons in his head.”

“How do you expect to make a mentally ill person better when you keep doing this to them?” Alford said. Instead of his anti-psychotic medications, a staffer at the jail gave him a Bible to read. “But he tore out the pages,” she said, “and used them to wipe himself.”

David Anguiano, a bipolar man in his 50s, was jailed in 2007 after shooting a gun at a residence during a psychotic breakdown of extreme paranoia. At first, records show, the jail provided him with the anti-psychotic medication Seroquel. But weeks later, in a cost-cutting move, the county changed its policy on prescription drugs for inmates, and the medication was withheld.

His sister, Marta Anguiano, said he quickly deteriorated and eventually went insane as she pleaded with jail staff—to no avail—to medicate him with an anti-psychotic.

Only after he was transferred to Metro State Hospital in Norwalk did Anguiano receive the proper medication and regain his mental competency, she said. But within a few days of returning to Fresno to stand trial, the jail disregarded the state’s treatment plan, and he quickly lost touch with reality again.

The mental breakdowns induced by the jail’s repeated denial of proper medication delayed the trial for nearly five years, she said. Last December, he was finally convicted of attempted murder and assault charges and sentenced to state prison, where he died a month later of a bacterial infection. He was 58.

Fresno County Sheriff Margaret Mims has tried to distance her office from mental care at the jail, pointing to county doctors.

“It was horribly inhumane. Without his anti-psychotic medications, he deteriorated so quickly that the voices and visions he would hear and see were constantly attacking him,” Marta Anguiano said. “‘Barbaric.’ That’s the term right there. It’s so cruel. It’s like they reach in and pull their hearts out. They treat the mentally ill worse than a homeless dog.”

Dominic Hanna, 44, was first diagnosed with bipolar disease at the Fresno County Jail in 2000 after an arrest on charges of taking topless photos of an aspiring teenage model. At the time, the jail provided him with Lithium, his anti-psychotic medication. Twelve years later, though, he found himself back in jail on charges of lewd and lascivious acts. This time, records and interviews show, Hanna was denied his prescribed mood-stabilizing medication.

During a three-day period, he attempted suicide twice. The second attempt—trying to suffocate himself by stuffing socks down his throat—landed him in an intensive care unit. He has been at the Fresno Community Hospital for more than a year, unable to stand trial, costing taxpayers for his medical care and the deputies guarding his room.

“I heard that they’re trying to save money. I don’t know how much they’re spending on Dominic, but it has to be something in the range of $1 million,” said Kathy Henderson, Hanna’s wife. “In the long run, it’s costing the taxpayers so much money. It would’ve been a lot cheaper had he gotten his proper care in the first place.”

The four highlighted cases are not out of the norm, said Marilyn Bokemeier, a longtime nurse in the Department of Behavioral Health who worked closely with mentally ill defendants as part of the county’s conservatorship team. She said she personally witnessed Alexander lose 80 pounds as he went insane, and she recalled another defendant who deteriorated to the point that he believed the county jailers were his sons.

“When these defendants are given their meds, they’re sane and intelligent and can help in their defense. But when the jail withholds treatment, to know them before and see them after, the deterioration is incredible to see.”

She said she became so disgusted with the jail’s abuse that she complained to her higher-ups. “I tried to challenge it. I went up the chain of command. I complained to my immediate boss, and he visited the jail and asked some questions. But nothing changed.”

A dispirited Bokemeier eventually left her job. “It’s really appalling that in this day and age the county is treating the mentally ill the way they are treating them. Ultimately, it’s the Board of Supervisors that needs to answer for this. Judy Case and Debbie Poochigian and Phil Larson in particular.”

Is Fresno County an anomaly? Have other counties in California, faced with tight finances, implemented the same practices at their jails? A spot check of public defenders around the state, while not definitive by any means, indicates that Fresno County stands on the extreme end when it comes to restricting psychotropic drugs to inmates.

In Sonoma County, as one example, the jail had been trying to save money by prescribing generic anti-psychotic medications, which were causing side effects in inmates and leading to mental breakdowns. Seven years ago, the sheriff sat down with mental health advocates and ended the practice. Since then, the jail has prescribed only high-quality anti-psychotics.

“What the jail was doing was not only inhumane, but it was pennywise and pound foolish,” said John Abrahams, Sonoma County’s recently retired public defender. “Clogging the courts and delaying trials because defendants aren’t mentally competent is no way to run a criminal justice system. So we joined the 21st century.

“I’m in contact with a lot of public defenders around the state, and I’ve never heard of other counties doing what Fresno County is doing. It makes no sense.”

The state of California tracks how many inmates move from local jails to state hospitals each year, a possible measure of which jails are doing a poorer job of treating their mentally ill. But a county-by-county comparison of these transfers is complicated by variables difficult to tease out. These variables include county size, jail population and the different reasons why mentally ill inmates seek such transfers.

Even so, when compared to counties of similar population size, Fresno County ranks near the top in the number of inmates it transfers to state hospitals. Over the past five years, state figures show, Fresno County has sent 386 inmates to Atascadero, Metro and Patton state hospitals. Of similar-sized counties, only Kern County, known for its hard-time jails, has seen more transfers during that period—492. By contrast, Sacramento, Contra Costa and Ventura counties have seen 61, 53 and 122 transfers, respectively.

In 2010, Fresno civil rights activists took their concerns about the jail’s treatment of the mentally ill to the Fresno County Grand Jury. The citizens’ panel agreed to look into the jail’s practice of restricting psychotropic drugs. But after input from Sheriff Margaret Mims and District Attorney Elizabeth Egan, the grand jury decided to sidestep the heart of the matter, saying the allegations included “a number of complex issues not easily analyzed or summarized.”

In the past, sheriff’s officials and public health administrators have defended the practice of limiting medications inside the jail as a necessary cost-cutting measure and a safeguard against defendants who fake mental illness to abuse the drugs or sell them to other inmates.

They have pointed out that the Fresno County Jail, unlike several other jails around the state, is not a licensed medical-psychiatric facility and cannot force inmates to take medications. In addition, many mentally ill defendants come with a history of failing to take their prescribed anti-psychotic medications on their own. Such factors, they suggest, lessen the jail’s obligation to administer expensive anti-psychotic medications.

But in recent weeks, county officials have begun to privately acknowledge that longtime jail psychiatrist Dr. Pratap Narayan went too far in seeking to cut drug costs, withholding anti-psychotic medication from some defendants with proven mental diseases. Narayan, the subject of an ongoing state medical board investigation into his professional competency, recently stepped down from his position at the jail and could not be reached for comment.

Under a new head psychiatrist, Mayur Amin, the jail has begun to implement changes, they say, including administering anti-psychotic medications to certain defendants, though not necessarily the drugs prescribed to them by their doctors or state hospitals. Dr. Terrell, for one, calls Amin “among the finest psychiatrists in the region” and expects him to make broad changes in mental healthcare at the jail. But he is “only one man,” Terrell cautions, and a political and bureaucratic imprimatur is needed to transform what has become a depraved culture inside county government.

The changes so far, critics note, have not come of the jail’s own volition but rather in the wake of a civil rights lawsuit filed last year by the Prison Law Office in Berkeley on behalf of seven former inmates, as well as inquiries by local journalists and investigators from the state medical board.

Because of the pending lawsuit and medical privacy laws, Fresno County officials say they are constrained in discussing the details of psychiatric care of particular inmates.

Last week, seeking comment on the overall picture, Arax and one of his Fresno State students visited the offices of Dr. Edward Moreno, the county public health officer who has presided over the jail’s curtailment of psychotropic medications. Moreno had failed to respond to a list of written questions. The reporters walked into the sixth floor offices of the public health department just as Moreno’s staff was bringing out platters of cookies, cakes, dips and sliced watermelon to celebrate his sending off. He had resigned, effective that day. Tina Starks of the department’s communication unit whisked the reporters into a back room, shut the door and politely apologized for Moreno’s “lack of a response.” He was in a meeting, she said, one of his last official acts, and he would not be seeing them.

This has left the burden of explanation to those down the chain of command, among them 31-year sheriff’s veteran Lt. Kurtze, in charge of the jail’s custody staff. Kurtze said the present jail psychiatric staff—10 nurses and technicians, three part-time psychiatrists and one full-time psychiatrist—is overwhelmed daily by questions of what medications to prescribe to what inmates. Those decisions are rarely black or white.

“[Inmates] may legitimately need the medication, I’m not denying that, but there is still the population that is seeking to feed their drug habit,” he said. “We have to decipher which are legitimate and which aren’t…We work hand in hand with Jail Psychiatric Services. It’s a joint partnership.”

Rose Ornelas of Jail Psychiatric Services concedes that mentally ill defendants often must wait 14 days and longer to see a jail psychiatrist and obtain a prescription, though visits can happen sooner if the defendant is suffering acute symptoms. “We are currently handling approximately 700 inmates on a rotating basis, with 10 staffers juggling some 60-plus case files,” she said.

Karen Nunez, supervising nurse at the jail, said if some defendants aren’t receiving anti-psychotic medications, the reason has nothing to do with costs. “I’ve seen some meds taken off the list because they were abused, but I’ve never seen a med taken off the list because it was too expensive,” she said. “I’ve been involved with this formulary process, and I can tell you it has never been a cost factor.”

But county public health records dating back to 2008 show otherwise. That year, George “Bud” Laird and Dr. Narayan, the public health officials directly in charge of psychiatric care at the jail, gave a progress report to the Board of Supervisors about the new restrictive drug policy. They had removed two anti-psychotic medications, Seroquel and Wellbutrin, from the jail’s formulary, citing high costs and the potential for abuse among inmates. Seroquel, alone, had accounted for 37% of the costs of all psychotropic medications dispensed by the jail, they said.

Laird and Nurayan reported that they had been able to reduce the use of Seroquel and Wellbutrin to near-zero levels. They boasted that the new restrictive drug practice would save Fresno County tens of thousands of dollars a month—a 59.8% reduction in the costs of psychotropic medications.

“Although cost savings would not be seen as a direct ‘goal” of treatment choices, it would appear that cost savings can result through careful determination of pharmaceutical usage,” they wrote.

But the list of anti-psychotic drugs they removed from the jail didn’t stop there. Soon, according to interviews and documents, every anti-psychotic medication used for schizophrenia or bipolar disorder was severely restricted. “It would be one thing if they limited just those two medications,” said Kelly Knapp, a lawyer at the Prison Law Office. “But they did the same with every other anti-psychotic medication. They’re all being withheld.”

While Fresno County has been careful not to adopt an official policy prohibiting the use of psychotropic drugs, a virtual ban is in place, interviews and documents show. Often, the way the jail psychiatrist justifies the denial of medication is to change the defendant’s diagnosis. No longer does an inmate suffer from bipolar disease or schizophrenia—his longstanding diagnosis. Suddenly, by measure of Fresno County, the defendant is only depressed or anxious. The jail then prescribes a much cheaper anti-depressant such as Zoloft or Prozac or, if it deems the defendant a faker, nothing at all.

“I see the same anti-depressants prescribed over and over,” said Knapp, who has reviewed hundreds of pages of medical reports and other documents as part of her lawsuit against Fresno County. “The county’s answer is, ‘We haven’t banned anti-psychotic medications.’ They say, ‘We give them to whoever needs it, but very few need it.’

“I’ve looked at 30 sets of records. They don’t find a bipolar person bipolar. They discount any previous history and make their own diagnosis. Sometimes they say the inmate is a malingerer, a faker. Other times they say the previous diagnosis is wrong to justify not giving the meds.

“I don’t know of a jail in California that refuses to consider the diagnosis of an outside doctor the way Fresno does,” Knapp said.

Changing a diagnosis to serve a bureaucratic end is more than just cynical, psychiatric experts say. It can be perilous, as well. Studies show that anti-depressants such as Zoloft and Prozac, which toy with the serotonin levels in the brain, can cause severe mania in some people with bipolar disorder. In this way, according to Dr. Terrell, the forensic psychiatric expert, Fresno County is not only triggering psychotic episodes by denying necessary medications, but it is also adding fuel to mental breakdowns by prescribing anti-depressants.

“One of the well-known side effects of anti-depressants is they can throw you into a full-blown mania and make you violent to the point of homicidal or suicidal,” Terrell said. “This happens to people with bipolar disorder and makes them much more mentally ill and makes them do harm to themselves and to others.”

Bokemeier, the longtime nurse, said the jail’s psychiatric staff was not above exercising the kind of self-justifying logic seen in the classic movie One Flew over the Cuckoo’s Nest. The jail denies an inmate his needed drugs and sends him into a tailspin. The inmate is then too paranoid to agree to a blood test. When challenged as to why the jail denied him his medication, the psychiatrist explains that the inmate is refusing to take a blood test.

Likewise, the bureaucracy of incarceration in Fresno County takes the instability inherent in mental disease and uses it against the defendant, she said. Because you refused your medications yesterday, staff tells an inmate, you won’t be getting your meds today or tomorrow. The disease itself thus becomes the pretext to make the disease worse.

“It’s this Catch-22 where the jail always wins and the mentally ill always lose,” Bokemeier said.

When such defendants then appear in court, manifesting every sign of mental instability, and worse, county judges are left to wonder. Before being assigned to juvenile court, Superior Court Judge Gary Orosco said he was forced to reconcile the accounts of public defenders that their clients were mentally unfit with the accounts of jail doctors saying the defendants were faking it.

“The jail calls them ‘malingerers’ but in a number of cases I came to the conclusion that they were losing their competency in Fresno County Jail. So when I got the chance to sign an order transferring them to a state hospital, I jumped on it. Problem was, they’d come back competent and then deteriorate all over again.

“I’ve expressed these frustrations on the court record. There are other judges here who have done the same. But there’s not much more we can do. We can’t be in the jail observing.”

Joanne Cox, who retired as a Fresno County jailer in 2010, said her fellow correctional officers often complained in private about the jail’s medication policy because it turned compliant inmates into problem inmates. They get put into isolation, “the hole”; they flush, flush, flush the toilet, she said. They demand toilet paper, and no officer wants to give it to them. Sometimes they have to be forcibly extracted from their cells, she said. Sometimes they have to be put on suicide watch. It makes for a hard time for the officers, too.

“I had officers telling me, ‘I hope I don’t get those psych inmates.’ They’d breathe a sigh of relief when they were being assigned to the Bulldog gang members,” Cox said.

Stephanie Negin, a Fresno County public defender, agreed that as crazy as it appears, the system has somehow sought to become as crazy as the inmates it drives to insanity. One of her current defendants, a young man with bipolar disorder, had become so paranoid after Dr. Narayan withheld his anti-psychotic medication that he refused to leave his cell. Transporting him from the jail to his court appearances became an ordeal, requiring nearly a dozen correctional officers, she said. His trial has been put on hold for more than a year. He is now seeking to regain his sanity at Atascadero State Hospital.

“He’d been a college kid, playing football, highly educated, earning 80 grand a year working for an insurance company when his first manic episode hit. He was arrested for attacking his father with a shovel. And the jail denied him his meds for 14 months. The county has forgotten that they are the caretaker of these people,” she said.

Negin said the jail’s treatment of the mentally ill often does not rise to the legally mandated level of a basic “standard of care.” Even though the jail is not a licensed medical-psychiatric facility, she points out, the care it affords must be no less than that given by other facilities in the community.

For the past six years, she said, that care had slipped to a shameful low. In recent weeks, since the departure of Dr. Narayan, Negin has noticed a positive shift as well. “The new jail psychiatrist is handing out some anti-psychotic meds. Things are slowly getting better, but I’m not confident the system will change until this community recognizes that mental illness isn’t a choice but a disease,” she said.

“We need a wider forum involving police and the jail, the courts, the Board of Supervisors, the district attorney, the public defender and mental health advocates. Because what has been happening here is absolutely horrible. As a community, we’ve ignored this for too long.”

Behind the mug shots and court dockets and orders signed by judges transferring mentally ill defendants from county jail to state hospitals—beyond the formulaic crime stories that appear in the local paper and are ripped and then broadcast on the local TV news—hide the tales, full of messy details, that a community would do well to hear.

What follows are four of those stories—none of them part of the civil rights lawsuit—told in a nutshell:

The Alexander family. From left to right: Wesley, Sharon, David, Marikah and her husband Marc Barrie.

Wesley Alexander

Wesley Alexander, now in his late 40s, grew up in the Tower District in a Craftsman-style home with an artist for a father and a chef for a mother. The setting, its Asian touches, was crafted around the notion of tranquility: towering bamboo and lush emerald gardens on the outside, polished wood shelves filled with thousands of books, many of them about cooking, on the inside. Dappled light shimmers everywhere.

In a kitchen where all things, then and now, revolve around a large black and chrome vintage stove, Sharon Alexander, his mother, took the recipes from those books and created a “foodie sensibility” for Wesley and his younger sister, Marikah. These same recipes then became a hit with Fresnans who frequented the downtown restaurant the Alexanders built out of an old two-story brick warehouse along the railroad tracks, Upstairs Downtown.

David Alexander, the father, designed jewelry for Neiman Marcus and Saks Fifth Avenue. Sharon jump-started the birth of ArtHop in Fresno. It was an unconventional household in the best way, friends say, with a little hippie thrown in.

As a child, Alexander was outgoing and extremely smart. His parents said he had a near photographic memory. But even at the age of three, it was clear he had trouble focusing and was hyperactive in a way that even rambunctious kids aren’t. As he grew older, he found expression in dance, and he would go from club to club, winning dance contests and picking up ladies. “He was very good looking, and he met girls everywhere,” his mother said.

His father recalled a trip to Los Angeles where Wesley was “doing his thing” on a street corner and an agent for Madonna circled the block to get another look at him and asked him to be in one of her music videos. Like so many other opportunities in his life, it never came to fruition.

He struggled as a student—he was bored by the busy work—and after graduating from high school, he flew out to Maryland to spend the summer with his aunt and uncle. The plan was to hang with his older cousin who would pass along some of his wisdom about preparing for college. Three thousand miles from home, and one week into his visit, Wesley was ambushed by his first psychotic episode.

The doctors there diagnosed bipolar disorder and immediately put him on Lithium. On the plane ride home, he overdosed on the drug and vomited. His parents put him in the Fresno Community Hospital’s old psych ward, where he remained for months.

To say his illness was a shock would not be completely accurate. It had a past, a genetic link. Wesley Alexander did not fall far from the tree. Although David and Sharon Alexander had been spared mental illness themselves, they only had to look back to an aunt on Sharon’s side and a grandfather on David’s side to find the psychosis and depression now clutching their son.

“The first depressive episode happened maybe about a year after,” Sharon said. “All of a sudden, he wasn’t coming out of his room. He stayed there all day, and he’d hide.” If the doorbell rang, his father recalled, Wesley would crawl under the bed and stay there.

Then one day he snapped out of it. The depression gave way to a normal period, a remission in the parlance of the disease. He was fine for months and months, and then they would notice a change. It was nearly imperceptible at first. His pace would quicken. His passions would become more ardent. His ideas would become more ornate and flowing. It was almost as if he had located a better version of himself. “He was just kind of edgy and zippy, but not out of hand.”

And then the full monster struck, and he would become highly agitated, irrational and delusional. He’d go out of town with friends and then disappear in an instant. Once he was found trespassing at a military base in the Bay Area.

During his 20s, Alexander went through long periods of remission. He moved out of the house. He did construction cleanup and then went on disability because of his mental condition. When he was doing well, he invariably fought taking his Lithium. Off the drug, he could fool himself, if not his family, that his sheer will had whipped the disease. But the delusions followed by depression would always return. With each new cycle, it seemed, the highs became higher and the lows lower.

As the phases came and went, sometimes in pattern and sometimes not, his parents became so watchful, so vigilant, that they could almost predict the ebbs and flows. “Whenever [Wesley] had a manic episode, that’s when we always got pulled in,” Sharon said. “That’s when I’d start doing everything I can to get him hospitalized.”

The older he got, the more frequent the psychotic breakdowns became. The stable periods grew shorter and shorter. That’s when he began to self-medicate, his parents said, drinking more and more quantities of alcohol. “We heard all these stories from friends that he would drink and pass out. Be unconscious,” Sharon said.

Then in January 2012, Alexander went to visit his former high school wrestling coach. As the two smoked marijuana in the coach’s apartment in the old Fig Garden area and began to reminisce, a secret came unburied. Memories turned into heated words, and shouts became a fistfight.

Alexander went for a walk to cool off. When he returned, he opened the door to find his coach on the floor with a self-inflicted bullet wound through his head. Alexander ran to his parents’ house. A manic breakdown was in full in pursuit. He came and went only to return in a delirious state at 4 a.m., banging on the door. The Alexanders called the police.

He was detained as a “51-50,” a threat to himself or others, and taken to the emergency room at Community Hospital. Declared “gravely disabled,” he was sent to the Crestwood Psychiatric Health Facility in southeast Fresno.

Over the next month, according to detailed notes kept by his mother, he was placed under county conservatorship. A psychiatrist at Crestwood gave him a battery of medications, including Lithium, and his condition soon stabilized. At Crestwood, where men and women live in the same facility, Alexander was caught in May 2012 having sex with a female patient in her room and charged with non-specific rape. He landed in the Fresno County Jail.

During his first week there, he didn’t contact his parents. This was unusual, his mother said. She called the jail and was told that her son had been placed in isolation. His conservator, Marilyn Bokemeier, told the Alexanders there was nothing she could do to ensure that their son would receive his anti-psychotic medications. That power resided with jail psychiatrist Dr. Narayan.

The Alexanders decided not to press a visit with their son, fearing it would be too emotional for Wesley and would set back his progress. What they didn’t know was that their son had no chance of making any progress. Denied his anti-psychotic medications, he was deteriorating more each day.

Last June, he was declared incompetent to stand trial. A public defender told his parents that his next hearing would be that July, and their son would probably be sent to Atascadero State Hospital to stabilize.

A week before his hearing date, however, the Alexanders got a call from Fresno Community Hospital. Wesley was severely dehydrated; his kidneys were shutting down. He wouldn’t speak to anyone. The hospital stabilized him and returned him to the jail. But the withholding of his Lithium continued, his parents said. He stopped eating and wound up in the hospital again.

By summer, his mother began taking matters into her own hands. She tried to contact Dr. Moreno and Dr. Narayan personally. She wrote letters to the jail and the local American Civil Liberties Union. Why wasn’t her son receiving his anti-psychotic medications? Why was it so hard to get any answers from Drs. Narayan and Moreno?

She then called Gloria Hernandez, a local patient’s rights advocate who advised her to contact Kelly Knapp at the Prison Law Office in Berkeley, which was putting together a lawsuit. She also talked to Fresno County public defender Stephanie Negin, who requested medical records from the jail, but never received them.

“I knew that my son was suffering. I’d drive by the jail and know that he was in there, and all these images would come to mind,” she said. “I knew that the only positive thing I could do was put all my energy into changing the system.”

It wasn’t until the end of October, after five months of incarceration at the jail, that Wesley Alexander finally made it to Atascadero State Hospital. There, he began receiving Lithium and Zyprexa, a second anti-psychotic medication. In a matter of weeks, his mother said, he stabilized.

Last November, the Alexanders visited their son in Atascadero for the first time. They hadn’t seen him in six months. What they saw, a son who had lost nearly 80 pounds, took them aback. “I was speechless when I first saw him,” his father said. “It was like some old man, some old wizened man. I couldn’t even get past that point. The image was so powerful I couldn’t get past it.

“[He had] long, long hair. His beard was just scraggly. He was absolutely just gaunt. Yellow. Just horrendous. Teeth missing.”

Said Sharon, “I am haunted by the vision of someone who did not resemble my son. His appearance and demeanor were shattering to me.”

Alexander told his parents why his teeth were missing. While in the Fresno County Jail, he had a severe toothache. He complained about it but received no medical attention, he said. Lost in delirium, Alexander had clawed at his gums, pulling his teeth out to ease the pain.

He told them how water in the jail had been shut off, and he became severely dehydrated to the point that his kidneys were failing. He told them he used his sock as a sponge to soak up water from the hole in his cell where he peed and defecated. That’s when he decided to kill himself. He slit his wrists with a razor and then covered himself in a blanket to hide. When he was found in a puddle of blood, some of the jailers were laughing and mocked him, he said. He showed his parents his scars.

In a recent phone interview with a Fresno State journalist, Alexander said he received Lithium once or twice in the beginning of his stay at the jail, but then never again. “They didn’t even draw blood to check my Lithium levels,” he said.

For now, Alexander will stay in Atascadero State Hospital. A trial date still hasn’t been set. But as long as he is receiving his anti-psychotic medications, far away from the Fresno County Jail, his parents are thankful.

“To play with their sanity and let them sit in isolation to face only their demons, that’s more than cruel,” his mother said. “That’s hell.”

Travis Fendley and his mother. His mother and aunt said they warned jail staff that Fendley would kill someone if he was released in a psychotic state. At 1:30 a.m. on Dec. 17, unknown to family members, Fendley was discharged from the jail. More than eight hours later, he showed up at the doorstep of his mother’s Clovis home.

Travis Fendley

Travis Fendley was born with a defect in his heart that mended with surgery. His family naturally spoiled him, especially his grandfather and grandmother on his mom’s side.

“Travis was spoiled rotten by my mother and father after the surgery,” said Pamela Frazier, Fendley’s mother. “They went camping and fishing while I was busy working as a single mom. He adored his grandma and grandpa.”

The little boy’s temper was out of the ordinary. By age three, he was destroying his toys and abusing the pets. “I had bought him this expensive electronic robot,” Frazier recalled. ”He walked right over to it and kicked it, smashing it to pieces—and with no emotion. One day, he threw my cat into a ceiling fan, and another one into a stucco wall.”

Even though her family had a history of diagnosed schizophrenia—a cousin and two aunts—no one connected Travis’ behavior to that lineage. School didn’t come easy to him. In the seventh grade, he began stealing liquor from the small store down the street and smoking pot. “The marijuana made him mean,” she said. “About this time, I was dating a guy that Travis didn’t like.”

One Fourth of July at the boyfriend’s house, Travis became upset and stormed out, walking home. Frazier sensed an explosion fast approaching and drove home, beating him there. By the time he arrived, his anger could not be contained.

“I wouldn’t let him in. He kept pounding on the door,” she said. “He grabbed a shovel out of the garage and broke out four double-pane windows and my sliding glass door. I was really scared. This was the first time he had directed his anger at me.”

Frazier called the police, and Travis ended up at Valley Teen Ranch, a kind of halfway house in rural Madera for out-of-control kids. He was tending to the farm animals and seemed to be doing well until the news came of his grandfather’s death. “While we were at the funeral for my father, I went to hug him,” Frazier said. “He pushed me away, and I saw the raging black coals in his eyes.”

Over the next few years, his violent outbursts escalated. He slashed the new leather couch with a razor and spray painted an antique oak table with carburetor cleaner. “One night he came to me and asked, ‘Mom, am I going crazy?’ He was hearing voices and seeing people up on the roof. He was certain they were spraying chemicals through the screen door.”

The search for alcohol or any drug to blot out the visions and drown out the voices began to consume his life, she said. She had a prescription for Vicodin and concealed the pills in her pillow. One night, he sneaked into her room while she slept, sliced open the pillowcase with a razor and lifted out the pills, she said. By the time he was 17, he was snorting and shooting Vicodin and washing it down with vodka.

His mother took him to the Community Behavioral Health Center in northeast Fresno, the first of many visits to the psychiatric facility. There, he was diagnosed as schizophrenic and prescribed Seroquel, Abilify and Prozac, according to interviews and medical records.

“The medications made him calm, but he was a little off,” Becky Alford, Fendley’s aunt, said. “When the sun went down, he’d get worse. He never slept, and he’d break his computers because he’d get himself so mad.”

His grandmother, Joyce Frazier, volunteered to take him in. If love could bring calm to his mental disease, no one loved him more than her. But in March 2010, he drove off in the middle of night with her car. She didn’t want to press charges, but police told her the decision wasn’t hers. He had violated his probation and was charged with grand theft auto.

“He made the news,” his aunt said. “He was happy that he was famous. He was calling everyone because he was on TV.”

A year later, he was arrested again, this time for striking his girlfriend who was pregnant with their daughter. He was given an eight-month sentence at the Fresno County Jail. Fendley’s mother and aunt knew what would happen if he wasn’t given his medications behind bars. They said they went down to the jail and made numerous phone calls to staff, pleading with them to make sure he received his medications.

“A nurse told me that it would be up to the psychiatrist to go over it when he gets around to it,” Alford said.

But the only medication he was given, they said, was Prozac, the anti-depressant. Confined to an isolated cell, denied his anti-psychotic medications for four months, he attempted suicide multiple times, they said. He slit his neck, cut his arms and tried to drown himself with cups of water, something akin to the torture technique known as waterboarding.

He was released in the summer of 2011. As his mother pulled into the Mervyns parking lot on Ashlan and Blackstone to pick him up, she could see he was deeply troubled. “I thought he was going to kill me. He came out with black eyes. He was pacing. He got in the car. I could see that he was gone. I told my sister ‘He’s going to hurt somebody. He’s going to kill one of us or somebody else.’”

She drove him to her mother’s house. There, his anti-psychotic medications had been placed on the kitchen table, but he refused to take them. Suddenly, he grabbed the bag of drugs and ran into the busy street. “I jumped in front of him, screaming, ‘Don’t do it.’ He looked like he wanted to hurt me, so I backed away,” Alford, his aunt, said. “It looked like he was running in front of the cars to get hit.”

In August 2012, Fendley was arrested for keeping a pellet gun in the garage, a violation of his parole, and sent back to the jail. He was released the following morning. By now, he had begun to keep a journal into which he scribbled his darkest thoughts, documenting a conversation with a voice known as the “spirit.” It was imploring him to take a final act.

You won’t do it. You’re too yellow. Do you wanna live in this life with Becky? No. Mom? No. Do you want a living hell, Travis? No. Then you have to do it. I’m so afraid. I know. You must be brave and have faith. You can kill easily. Yes. The children. Will the children live? No. Did I sign the contract? Yes. Has to be done a certain way, right? Yes. How? Suffocation. Are you God? Yes. Pray with me. Go away. Yes. Grandma first. Debbie, Bill, Lisa, Ethan.

As the voice grew more insistent, Fendley found himself back at the Community Behavioral Health Center. His mother said she begged doctors to keep him over the weekend and consider committing him. But the center refused to declare Fendley a threat to himself or others and place a 72-hour hold on him. “He kept arguing, and they released him,” Frazier said. “I knew he was going to kill someone this time.”

Fendley returned to his grandmother’s home near Shields and Fowler avenues. She refused to give him money to buy alcohol, and he hit her over the head. Alford said she drove to her mother’s house and found her mother sitting quietly at the kitchen table, a phone in her hand. She had just called police. Fendley was arrested and put back in jail.

He was there for three weeks, they said, locked away without the benefit of anti-psychotic medications. His mother and aunt said they warned jail staff that Fendley would kill someone if he was released in a psychotic state. At 1:30 a.m. on Dec. 17, unknown to family members, Fendley was discharged from the jail. More than eight hours later, he showed up at the doorstep of his mother’s Clovis home.

“His eyes were black, and he just asked me if he could stay here,” Frazier said. “I said ‘No.’ When he left, I called my mom and told her not to let him inside because she always lets him in.”

His grandmother made him sandwiches but told him it was better that he not stay there. Fendley couldn’t believe even she was turning him away. His mother and aunt, hoping to take Fendley to the Community Behavioral Health Center, gathered his clothes from the garage. His grandmother hugged him tight.

As his aunt drove him to the psychiatric facility, Fendley jumped out of the car near Fresno State. “He kept telling me, ‘This isn’t going to turn out well,’” Alford said.

Fendley ran back to his grandmother’s house, pleading with her let him in. It was cold outside, and his grandmother didn’t want him getting sick. The next morning, on Dec. 18, Alford called her mother’s house and spoke to her nephew.

“Travis said Mom was sleeping. I called back two hours later, and he said she was still asleep. I called again 20 minutes later and there was no answer.”

Alford immediately drove to her mother’s home. She opened the door. The house was quiet. Not even the dog was barking. Alford knew something was wrong.

She walked into her mother’s room and found her on the bedroom floor. Fendley had suffocated his grandmother until she lost consciousness, then he placed a few of his fingers on her throat until she could breathe no more.

Police told Alford that her nephew’s plan was to kill his grandmother first and then kill her, his mother and her four-year-old grandson before killing himself. “I went to the jail to ask Travis why he did it,” Alford said. “He said he heard the voice of his child’s mother in his head, and she told him to kill.”

This past March, the family was told by an attorney that Fendley still was not receiving his anti-psychotic medication in jail. He was locked up in what is known as “the doghouse,” a one-man cell with a camera. He’s lost more than 40 pounds. He says he’s eating, but the demons inside him are “sucking the food out of him.”

“The guards open it once every hour to ask if he’s alive,” Alford said. “I called Travis the day after Mom’s death and asked if he had a TV in his cell. ‘No,’ he told me, ‘but I talk to my spirits.’”

David Anguiano

When Marta Anguiano looks at her brother’s life, she can’t help but draw a line. There was the David before the accident and the David after the accident. It happened in March 2000. Before that, her brother showed no real signs of mental illness, much less bipolar disorder.

“He was what they call a ‘weekend alcoholic,’” she said. “He experimented with some drugs in high school and had a few arrests but nothing major. After the accident everything snowballed.”

Her brother was commuting to San Jose from Fresno every day for his job as a foreman at an electrical company. On the night of March 24, 2000, he got home, opened a cold beer and noticed that his neighbors were gone and their dog was missing. As he walked outside to look for the dog, he tripped over a broken piece of sidewalk pavement. His shoulder, knee and head slammed into the ground, snapping his neck out of place. The beer bottle he was holding nearly sliced off his right hand.

Surgery saved his hand, but Anguiano lost his job.

“He fell into a really deep and very severe depression,” his sister said. “He lost his job and lost the use of his arm. He planned to buy a home in the Bay Area by the ocean. He was going to take my mom with him and basically live happily ever after working at what he loved doing. But the accident completely ended everything.”

He started to self-medicate and was arrested several times for driving under the influence, she said. A Navy veteran, Anguiano enrolled in a substance abuse program at the VA hospital in Fresno. In 2005, medical records show, he was diagnosed with post-traumatic stress disorder and depression and prescribed Seroquel for hallucinations and paranoia.

His psychosis continued, his sister said, in part because he began abusing crack. By May 2007, he was so delusional and paranoid that late one night, he grabbed a submachine gun he had bought to protect himself and drove to an apartment complex to confront a man who had been harassing him for money. He then fired several shots into a unit where the man lived with his wife and child.

He was booked into the Fresno County Jail on charges of attempted murder and assault with a deadly weapon. Because his VA doctors had prescribed Seroquel and Effexor, an anti-depressant, his sister expected the jail to at least continue the medications. But documents show that on May 31, 2007, the jail decided to give him a different anti-psychotic medication, Risperidone.

Then that August, citing high costs, Fresno County decided to severely restrict all psychotropic drugs at the jail. David Anguiano was one of the first mentally ill defendants to be affected by the new practice. Denied his anti-psychotic medications, his sister said, he fell into a prolonged psychosis.

Marta Anguiano said she sent repeated e-mails and faxes to the jail staff pleading that her brother be given his prescribed medications. On Sept. 18, 2007, her e-mails show, Sheriff’s Capt. Tom Gattie replied. He stated that Dr. Laird, the jail psychologist, had seen her brother three times and assured Gattie that proper care was being provided.

Over the next several months, she continued to write e-mails to the jail staff and others that her brother was not receiving proper care for a variety of ailments, including his mental illness.

“I faxed all his medical and mental documentation that I had to the medical jail staff,” Marta wrote in one e-mail to a state corrections official, recounting her tireless efforts. “When they administered his depression medication, they had him on it for a while and stopped it abruptly without any warning to him. He asked for his medication for schizophrenia, and they told him they didn’t have it on their formulary.”

It took a full year, but Anguiano was finally admitted to Metro State Hospital on May 28, 2008, documents show. His care changed almost immediately. State doctors prescribed him the anti-psychotic Abilify and the anti-depressant Cymbalta. Records show that he spent a year and a half at Metro, regaining his competency.

In the discharge summary, Dr. Yatin Patel, a Metro staff psychiatrist, provided a detailed list of medications that Anguiano needed to take each day. He wrote that his prognosis with medication was “fair.” Without the proper anti-psychotics, his prognosis remained “poor.”

In a now routine practice, the Fresno County Jail refused to heed the advice of the state hospital. As soon as Anguiano was returned to the jail, his anti-psychotic medications were pulled away. Instead, documents show, the jail psychiatrist prescribed him an anti-depressant.

So began a four-year cycle in which Anguiano, denied the proper drugs, would become insane and then be sent to Metro State Hospital where he would be given the proper medications and regain his mental competency, only to be returned to the Fresno County Jail where his medication would be yanked, and he would fall into psychosis again, records show. From 2008 to 2012, he ping-ponged between the jail and the state hospital at least 10 times.

“He was fine at the [state] hospital,” Marta said. “He was very rational. And then he would be returned to the jail and deteriorate. The medications weren’t in his system anymore, and he wouldn’t know what was happening. The voices and hallucinations, all of that would start coming back. And you could see it in his face.”

By January 2011, Fresno Superior Court Judge Gary Orosco had issued a court order for Dr. Howard Terrell to evaluate Anguiano’s competency. “I am concerned that the defendant is not currently receiving proper psychiatric treatment at the Fresno County Jail,” Terrell stated in his report to the court.

“Had he been continued on the same anti-psychotic medication he received at Metro State Hospital, I believe it extremely likely that he would have remained competent to stand trial.”

Terrell predicted that if Anguiano did not receive his anti-psychotic medication, he would lose his mental competency and be forced to return to Metro State Hospital, further postponing his trial. In fact, Anguiano would be sent to the state mental hospital three more times in 2011.

It wasn’t until Nov. 8, 2012, five and a half years after his arrest, that Anguiano was deemed competent to face trial. Six weeks later, he was found guilty and sentenced to 25 years to life at Wasco State Prison. A month later, on Jan. 30, he succumbed to a bacterial infection.

His funeral this past March was a small affair. Family and friends gathered on a warm Saturday morning at St. Peter’s Cemetery in southwest Fresno to remember a man with a “big heart” and an “endless sense of humor” who cooked and cleaned and took care of his ailing mother until she died.

His sister carried his ashes in a wooden box hand-carved by her husband. She had painted the symbols of ancient Egyptian history that her brother so loved, including the god of death, Osiris. One by one, she carried the box to each family member who kissed the top and said a final goodbye.

She had buried her brother, but not her anger.

“I don’t think it’s very just,” she said. “There has to be a major shakeup. That’s why we intend to sue. This can’t continue. There’s so many that are being abused and taking advantage of in that jail. They’re just in there, in their own world, being tortured by their psychosis.”

Dominic Hanna

Kathy Henderson met Dominic Hanna in October 2003. He was a delivery driver for a local tortilla company, and she was going to school to earn her teaching credential. She was 35, never married. He was 32 and divorced. He impressed her with his smooth and polished style, his openness.

They talked for hours that first date. Hanna even told her about his past—his bipolar disorder and a conviction that landed him in jail three years earlier. He ran a photography studio in the Tower District at the time. One day, a 17-year-old aspiring model asked him to take more “provocative photos” for her portfolio. With her boyfriend present, Hanna took topless photos of the girl. He was arrested and charged with lewd acts with a minor. He pleaded guilty, spent nine months in jail and was forced to register as a sex offender.

It had been the psychiatrist at the Fresno County Jail who first diagnosed him with bipolar disorder, Henderson said. He was behaving oddly, and the jail doctor prescribed him Lithium. The medication seemed to work, and he and Henderson decided to get married in December 2004.

“Our relationship was pretty normal,” Henderson said. “As long as he was on his medication, he would continue to work and our relationship was good. Things were normal for us.”

She was teaching first graders in San Joaquin, and he had started his own T-shirt company. From time to time, he would become depressed but nothing major, she recalls. Then, for reasons she doesn’t know, Hanna’s psychiatrist took him off Lithium and gave him Adderal, which is typically prescribed to patients with attention deficit hyperactivity disorder (ADHD).

In the summer of 2010, Hanna went to Las Vegas to sell shirts during the World Series of Poker. “That’s when things started to get rocky,” she said. “I went to stay with him for the month, but he was acting very strange. He didn’t sleep much.”

His mind began to race with important formulas that needed to be taken to professors at the Massachusetts Institute of Technology, he told her. The world was nearing an end, he believed, and these formulas would avert the apocalypse. “He wouldn’t let me sleep,” Henderson said. “I couldn’t function anymore. I had to leave. I didn’t want to, but I had to.”

Henderson moved into her parents’ home in Hanford. Hanna would call her dozens of times a day, rambling on and on about his formulas. “The conversations would start nice, and then he would threaten to get violent,” she said.

Hanna then threatened to kill Henderson’s parents and himself—so she would have to live with the guilt. “I reported it to the police. He was told not to come to Hanford, but he did, and he was arrested.”

He was taken to the Kings County Jail in February 2011 and charged with making terrorist threats. Almost immediately, Henderson said, she received a phone call from a mental health nurse at Kings County. She was calling to confirm that Hanna suffered from bipolar disorder and to review the medications he had been taking. Kings County prescribed Hanna the mood stabilizer Lamictal, Henderson said. In no time, Hanna started to return to “normal.”

He spent a year at the Kings County Jail, pleaded guilty to a lesser charge and was given probation. He moved to Fresno and rented a hotel room off Shaw Avenue, Henderson said. But a month later, in February 2012, Fresno police arrested Hanna and charged him with lewd and lascivious acts with a girl under 14—a crime that allegedly happened back in 2004.

Hanna couldn’t believe what was happening to him, she said. Just three weeks earlier, he had cleared a warrant check when he was released from the Kings County Jail.

On Feb. 6, 2012, he was booked into the Fresno County Jail. Henderson said she immediately called the jail staff to alert them to his deteriorating mental state—and the fact that he needed Lamictal to counter his depression. Indeed, taking the drug was a condition of his probation, she said. But she never heard back from the jail.

“The arrest put him in a depression. He called me that day, and we talked. He kept saying, ‘I can’t deal with this anymore. I don’t want to go through this, and I don’t want to put you through this. I’m going to kill myself. This is it. I’m saying goodbye.’”

A day later, on Feb. 7, she called the jail again. “I left a message on the phone that they needed to watch him. I called the watch commander but no answer. The next day, Dominic called me from the jail. He said he had fallen off the bunk bed. I later learned from an attorney that he did a swan dive. He tried to kill himself.”

Denied his mood-stabilizing medication, Hanna attempted suicide again the next day, stuffing a sock down his throat. Because of a lack of oxygen, he had suffered extensive brain damage and was taken to the Community Regional Medical Center’s intensive care unit. A feeding tube was inserted into his stomach, and he eventually stabilized enough for the hospital to send him to a nursing home.

There, in a last attempt at suicide, he tried to stuff the bed sheets down his throat.

Hanna was transported back to the hospital’s sub-acute unit, and that is where he remains today. He can barely move his arms and legs. Bedridden, he is unable to clean himself. He is never without a diaper. His brain damage is such that he talks in the manner of a six- or seven-year-old.

“When I visit him, he’ll tell me he doesn’t know who I am, and he can’t remember a lot of things,” Henderson said.

As he has for the past year, Hanna remains under the care of the Fresno County Jail. It is not clear if he will ever be well enough to stand trial. And yet he remains under the 24-hour guard of sheriffs, racking up expenses to an already outsized hospital bill.

“This is what the jail’s refusal to give him his meds has brought,” Henderson said, noting the irony. “They’re responsible for his care now.”

*****

From the Editor: About This Article

Mike Rhodes

This is the first time the Community Alliance has published a Special Edition. When Mark Arax, who is a Fresno State journalism professor and arguably the best writer in the Fresno area, approached me about the jail/mental health story a couple of months ago, I knew it was the kind of article we wanted to print.

I have read several of Arax’s books, including In My Father’s Name and The King of California, which tell the remarkable history of our lives in Fresno and the Central Valley.* Those books and his years of investigative journalism as a writer for the Los Angeles Times left me with no doubt that he could make the story about what is going on within the Fresno County Jail come alive.

If you are an editor for a small alternative/independent newspaper, having someone like Arax write for you is about as good as it gets. But now, not only do we get the benefit of Arax’s significant skill to help tell this story, but he is also teaching the next generation of journalists how to write news stories. Almost too good to be true, eh?

Because of technological developments, there are those who want to write an obituary for newspapers, and think that investigative journalism is dead. Projects such as this Special Edition are evidence that rumors of our demise have been greatly exaggerated. This is our best argument that even in the world of the Internet, Facebook and smart phones quality journalism will survive. I believe readers need and will continue to demand in-depth information about the world around them that you simply can’t get from a source like Twitter, which limits you to 140 characters.

Arax and his students have worked on several great investigative articles in the Fresno Bee. They did the research that led to the story about Tony Vang not living in the district he represented as a trustee for the Fresno Unified School District (FUSD) and wrote a groundbreaking story in the Bee about the dropout situation in FUSD. The Bee’s publishing of those stories gave visibility to important issues that probably would not otherwise be brought to this community’s attention. Elected officials were removed from office and public policy changed as a result of these articles.

One of the great things about having several newspapers in Fresno is that writers have more than one publishing option when they have an important story to tell. We are honored that Arax and his students have chosen the Community Alliance to tell their story about the appalling conditions within the Fresno County Jail.

It has been a logistical challenge for us (a small, mostly volunteer group) to produce this Special Edition and get it into your hands. Let us know if you like what you read and want us to publish more investigative stories by Arax and his students. Another way you can show that you like investigative journalism is by clipping out and mailing us the subscription form below.

*I strongly encourage readers of the Community Alliance to get a copy of Arax’s books. They are wonderful to read and will tell you things about your community that you probably didn’t know. For example, In My Father’s Name details the crime and corruption (in the highest places) that has made Fresno what it is today—such as a former police chief who was involved in graft and corruption, who ended up marrying the woman who ran prostitution in the city.

Fresno State Students Break Key News Stories
By Community Alliance Staff

Fresno State journalism students under the direction of professor Mark Arax have produced some of the more memorable and groundbreaking stories in the local media over the past two years.

When Arax heard about the 2011 stabbing death of a Roosevelt High student who was a member of the school’s rugby team, he sent student journalist Vongni Yang to follow the team through the rest of the season, producing the inspirational narrative, “The Rugby Boys of Roosevelt High,” which appeared in the Fresno Bee.

The following semester, another student in Arax’s class, Tracey Scharmann, spent six months reporting and writing a series of stories on the broken state of the Fresno Unified School District (FUSD). The series, also appearing in the Bee, explored the district’s failure to solve its alarmingly high dropout and truancy rates, forcing a reluctant Superintendent Michael Hanson to set up a graduation task force.

Last year, two of Arax’s students, Alan Wileman and Sam Cosby, generated a piercing investigative story on the scandal-plagued New Millennium charter school. It revealed how FUSD Trustee Cal Johnson was being paid thousands of dollars a month by New Millennium and never showing up for work and how Hanson failed to follow through on a decision to close the school—and then publicly lied about his reasons for not doing so. Published by the Bee, the story prompted an investigation by the Fresno County grand jury and forced the school board this month to finally revoke the school’s charter.

It was Arax and his students who first discovered that the FUSD was handing out tens of millions of dollars in no bid construction contracts—funded out of Measure Q—to Harris Construction, the same company that had teamed up with Mayor Ashley Swearingen and Hanson to fund the very campaign to pass Measure Q.

Arax and his students were also the first to confirm that FUSD Trustee Tony Vang, while representing the McLane High area, had built a home in the Clovis Unified School District and was living there for seven years, violating election law and lying to his constituents. That revelation, after months of his denial, led to his resignation.

22 comments to Freefall into Madness: The Fresno County Jail’s Barbaric Treatment of the Mentally Ill

This is what good reporting and a free and independent press is supposed to do: keep those with power over the lives of others from quietly and secretly abusing that power. This should provoke extreme concern and outrage. These horror stories can impact any family as mental illness strikes without prejudice. It could be our own loved ones being abused and tortured this way, and it costs us all dearly.

This is beyond shocking. This has to qualify for criminal neglect on the part of everyone involved, particularly the sheriff, several members of the board of supervisors, the jail psychiatrist, and those in charge of the jail itself.

We need a recall for the sheriff and several of the board of supervisors, starting with the heartless Judy Case (a nurse, amazingly).

So deeply sad but worse such barbarism, lack of humanity! No possible excuse and as far as I am concerned absolutely criminal! In addition how frightening is this whole situation? Who is the keeper and who is the kept? How to tell the difference? Unbelievably unconscionable! Cruelty personified!

What a prolific expose on the torture of the mentally ill! How can they return to their communities as better citizens if they are traumatized and maimed in jail. These practices ultimately endanger the public safety because most of them will come home. When a prisoner is having an episode, the staff is at risk too. What a stupid thing to do, deny prisoners meds. Well done Prof. Arax and students.

such corrections! cruel but not unusual. funny they can force feed but not force medicate. meanwhile on the other coast, Rikers alone has more seriously mental ill than ALL New York State’s mental facilities combined!

What an outrage! If I were queen I’d round up these officials and put them in cells, induce phychosis in them. Withhold meds. See how they like it. Oh yeah, make ‘em all lose 80 pounds too. But, I have a feeling even that wouldn’t change them because they are obviously a bunch of sociopaths. Add those laughing jailers too. Sheesh I am mad about this!

jan: worldwide 1/125 has schizophrenia. it IS oir friends and loved ones. the comments re triple stabings in s.jose (?) was full of aquaintences who were shocked. 1/125 just schiz. ome of several SEVERE MENTAL ILLNESSES…not tp be cpnfused witj the minor ones which selectovrly get treated…low hanging fruit. more successes, more pleasant patients,

One of the best stories I’ve read anywhere about this barbaric situation in Fresno. People of compassion need to get involved and put pressure on the county and on the sheriff to make sure these human beings get the medications they need. Otherwise, the county and its citizens are guilty of barbarism.

Firstly most people with these mental problems quit their own meds and thus ended up in jail or homeless.
Secondly if we find they need these medications they should be moved from the jail to a mental patient facility!
Mistakes are made when we assume all mental patients have someone towatch over them! Living like animals as a homeless person in itself is tragically “Mental”. But putting the mentally ill in jail? Never ! Even on their meds they have a tendency to rebel against simple care. Build the asylums its obvious people are tired of taking care of their own family crazies unless they are the cute docile kind.

While Arax’s story is compelling, it leaves out some important preliminary work done by Greater Fresno ACLU in amassing family and inmate testimonials to this horrible treatment. Many of these same activists went and testified before the Fresno Grand Jury before they responded with a basic whitewash report saying their was no problem. But it is to Arax’s credit (and his students) that they did come out with such a detailed report of the suffering going on at Fresno jail. I hope it will open the eyes of many in power and the community itself.

wesley alexander master at manipulation, he doesn’t take his meds he cheeks them, he raped a old lady at the phf , and the phf tired to cover it up , the jails are not made to hold these long term mentally ill people and the local phf can not hold them when they do crimes there on others and staff,

he has a very long history and he finally got caught, he should have never got out of the state hospital the 1st time(s) he is and has been “conserved” by the state and he got placement in late April 2012 to Santa Cruz but held a sharpen tooth brush to staff there so he could come home to see his mom and dad, and they have been fooled all these years by him ,

even if you don’t care morally about the prisoners….. the citizens of Fresno Co should be outraged by the waste of tax dollars of lawsuits and the continued care of the prisoners. the citizens need to educate themselves of who they are voting for and what is going on with their tax dollars. Millions will be spent to save a few 100.00. It is really insane.

thanks for the report. I feel less alone in my 850 day hell with my son’s very similar experience except his was with Lerdo Jail in Kern Co and Wasco Rec Center. We just don’t know what to expect from Atascadero. We love our son and he lost weight at Vacaville until he looked like a POW. I cannot cry or function well, our whole family is suffering. What can be more delusional than allowing a prisoner to refuse meds that they require. It as cruel as denying them. I cuss so much all day long that I am afraid I will lose my health from the insanity of the system.

Has anyone informed the Board of Corrections, Federal Dept. Of Justice Special Litigation Division regarding these matters. Your best option besides a lawsuit would be to notify Senator Feinstein and authorize her to look into this matter. She is in charge of insuring all Federal Agencies do their jobs including the F.B.I who like to stall you and hide behind their desks.

I am so grateful for this article, I have been seeing my son go through this for years in prison, while being denied medication and I have been told when he first entered the prison 16 years ago that he did not suffer from mental illness I was floored! I had plead with them to please give him his medication and finally at one point he had been Kahia-ed and force medicated at one point and then denied all medication while being in Ad-seg which is an Isolation Unit where his condition has worsened. He was He also has been charged in 2009 and 2010 for threats to C.O.s at Tehachapi State Prison in the evil Kern county and still they are trying to convict in in a court of Law and still my son has gotten worse from schizophrenia to schizo effective bipolar type. The details are all these horrific are also practiced in state prisons. I have seen my son looking like a nazi prisoner as well very psychotic and not well at all. My son has been tortured, brutalized and criminalized for acting out in untreated mental illness.

Today 5/27/14, my grandson took a plea deal to a inflict corporal injury on a spouse., in the Kern County Superior Court System. Since this his 3rd offence he will be sentenced to a 4 year prison term. The day my grandson was arrested, 4/12/14, I asked the Bakersfield Police Department if he could be allowed to take his psychotic medication with him and I was advised my grandson would be checked out by the nurse and given his medicine then. He has made about eight request and has not been evaluated. I asked his public defender, Elizabeth Camacho if my grandson would be given his psyche meds and she advised when he would be paroled, they will give him his medicine. Who is they? And why not give him his meds now? Is this common procedure?

I know that that the focus is on mental illness but I think that it’s fair to say that Fresno county has a very poor level of medical care period. I think that the whole jail should be investigated. I’ve experienced it first hand and know several people that have been denied medical treatment period one of which is diabetic and had been sick for a month and 2 days later after being released had his toes amputated. It’s disgusting how they treat these people and no one gives a crap because they are seen as criminals. And most of them are not very educated and don’t have the money or resources to try and fight it or no one listens to them anyway because they are labeled as criminals. Fresno county has been getting away with this for years and years and something needs to be done to make them accountable for their actions or lack of.

would like to know of any lawsuits going on that I can be a part of I was held there nearly six months without any medication and when I withdrew from my medication I was taking on the street it was it it was terrible

Sigh….as someone who is an advocate for the mentally ill and works as a nurse specializing in psychiatric patients I hate to have to be the Devil’s advocate for this article (especially since I agree with its message and most of the comments)

I have worked personally with one of the cases mentioned above, in a different facility, after this article was written, where they were actually receiving psychiatric meds. In fact this patient was highly OVER medicated with muscle relaxers and anti-anxiety meds round the clock.

He is convicted of several counts of sexual assault, many against minors, and would consistently make lewd and innappropriate sexual comments to female staff. He admitted he was feigning the symptoms of his mental illness to avoid going to trial, and he was indeed found competent and sent back to jail. On his last day on our facility he was quoted as saying “I’ll miss your ass the most it’s perfect”

He is not deserving of the ‘millions’ of tax payer dollars that medicate a made up illness and allow him to sleep all day instead of facing his charges.

It is very SAD TO BE A VICTUM……Let alone by cops
.
The police were who assisted with crimes of grand theft auto
Repeated BURGLURIES. Denying My assistance…beat up.. KIDKNAPPED…to force me to sign over all assets…..sixty…..different police responses.. I am 54 YRS old. I weigh 100 lbs…and Fresno swat at task force…..has made five raids on my life only to steal more of my stuff. Divorcer from 30 YRS marriage almost killed marked for target in their crimes…they can do what they want……::I am no homeless now. During bankruptcy. Automatic stay. Swat team broke into my home drug me out. Made me leave losing all my stuff…while crooked lawyer took possession of my home…..how’s that…..no court order….the BK stay protects from all action….they had no warrant b said they were looking for guy who almost killed me a YR ago……turned out he was waiting in Stockton jail for them….turned loose due to fed. No show……I have war to try to get thru. LAwyers PD off throwing me in Mudd…..I am not a bad person…more to my story but got to go. God bless you for reading and PRAY for safety of us all